Expert: Mary Gordon - 5/16/2010

Question
I have turned to you once again for infomation because you have been so helpful in the past. The nursing home where my 88 year old mother-in-law has been living called us this morning to tell us that they had noticed mottling starting in her feet and legs yesterday and that it was in her hands and arms today.  They said it was the start of the end process.  What do they mean by this?  Are they saying that she is dying?  We are not getting much in answer from the nursing home.  I appreciate your help so much.

Answer
Hi Deirda, you don't mention anything else about her condition.

Skin mottling CAN be a sign that death is approaching in the coming weeks or days. Everyone is different but common signs include:  

- sleeping more and more, and becoming less and less responsive
- lost of interest in food and drink (they don't seem to feel hunger or thirst at all)
- urine output slows down, and the urine becomes tea colored (i.e. due to concentration, and a sign kidney's are shutting down)
- extremities become cool because the circulation is decreasing
- a few people have periods of restlessness and disorientation (i.e. their hands may wander and pluck at the bedclothes)
- changes in their breathing pattern, such as periods of rapid, shallow breathing, or shallow breathing with a space of five to 60 seconds between breaths (called Cheyne-Stokes breathing).
- rattling sounds in the lungs and throat (it doesn't mean they are uncomfortable although it sounds awful).
- mottling of hands and feet caused by slow blood circulation. Sometimes their underside will become dark as blood starts to settle, or they will develop paleness or grayness in the face or around the mouth.  

Here is a couple of web pages describe these signs in more detail
http://www.amitabhahospice.org/public/helpful_info/signs_of_dying.php
http://www.caring.com/articles/signs-that-death-is-near

If she has been seen by the doctor, you might want to speak to him or her and find out what they feel the prognosis is. Normally mottling is a late sign of death approaching, so if this is what the doctor thinks is going on, you need to know so the family can prepare for the final days.

Hop this helps - I'm thinking of you, and hoping everything goes the way you would want for her.

Mary